Category II Codes in Brief

Category II Codes in Brief

Reporting of category II codes is optional, but has advantages. The AMA, which creates and maintains CPT®, states that category II codes “are intended to facilitate data collection about the quality of care rendered by coding certain services and test results that support nationally established performance measures and that have an evidence base as contributing to quality patient care.” For example, category II codes:

describe clinical components that may be typically included in evaluation and management services or other clinical services and, therefore, do not have a relative value associated with them. Category II codes may also describe results from clinical laboratory or radiology tests and other procedures, identified processes intended to address patient safety practices, or services reflecting compliance with state or federal law.

Additionally, per the California Quality Collaborative, the advantages of assigning cat. II codes include:

  • Lessened administrative burden of chart review for many Healthcare Effectiveness Data and Information Set (HEDIS™) performance measures
  • Enables organizations to monitor internal performance for key measures throughout the year, rather than once per year as measured by health plans and Pay for Performance.
  • By identifying opportunities for improvement, interventions can be implemented to improve performance during the service year.

Category II codes are supplemental. You should never use them “in place of” category I or category III codes.

John Verhovshek

John Verhovshek

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.
John Verhovshek

About Has 474 Posts

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.

One Response to “Category II Codes in Brief”

  1. Heather Willingham says:

    We are in an ACO (Accountable Care Organization) and they are wanting us to report CPT II codes on a lot of different patients. Patients that have diabetes, hypertension, etc. Is this something that we should do, or can you not answer that because it would be part of our contract with them. As far as Medicare patients go, would it be more wise to do the reporting of these codes or not?

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